Description
This quick guide provides troubleshooting for the insurance portion on treatment plans and invoices when it isn't calculating correctly.
Steps
- With the correct patient selected in the Sidekick, click Insurance.
Double-click on the patient's Insurance Policy to view the Insurance Policy Information.
[word insurance in the sidekick in a box, insurance policy from insurance module in a box]
Click Edit Plan to view the Insurance Plan.
[policy info with edit plan in a box]
Check the coverage details to verify they are correct.
[insurance plan info with coverage details in a box]
The Coverage Details at the bottom of the insurance plan has several items which will be taken into account when the insurance calculation is created for a treatment plan.
Maximums
If these are not entered, an insurance portion will not calculate. If there is no family maximum for this plan, it will be set to Unlimited.
[insurance maximums edit page with standard in a box, showing unlimited in family column and an amount in individual column]
If a category has a separate maximum, or no maximum, the boxes beneath "Covered by Standard?" will be unchecked with the applicable maximums set for those categories.
[edit maximums pop up with box around preventative through ortho, showing preventative and ortho deselected with 0 for preventative maximums and an amount in ortho maximums]
Deductibles
Deductibles must be entered in both the Individual and Family columns. If there is no family deductible for this plan, it will be set to Unlimited.
[edit deductibles pop up with box around standard in a box, showing unlimited in family column and an amount in individual column]
If a category has a separate deductible, or no deductible, the boxes beneath "Covered by Standard?" will be unchecked with the applicable deductibles set for those categories.
[edit deductibles pop up with preventative through ortho in a box, preventive unchecked with $0 amounts, ortho with amounts in individual and unlimited in family]
Payment Table
When Curve Hero is determining the insurance estimate and the annual maximums have been entered, it will first check the Payment Table for dollar amounts. If there is nothing entered for the procedure on the Payment Table, Curve Hero will then check the Coverage Table and if there is no percentage entered for the procedure, Curve Hero will list the total fee as the patient's responsibility.
[coverage details with edit payment table and edit coverage table in a box]
Click Payment Table to verify that the incorrect amount has not been entered for the procedure.
[Edit payment table open with the first code and amount in a box showing it has a fee entered]
If the amount shows $0, the insurance portion will calculate at $0. If this is inaccurate, delete the amount for that procedure in the Payment Table. The insurance estimate will then look to the coverage table to calculate the insurance portion.
[Box around procedure and empty amount in the payment table, note saying "If $0 is shown, insurance will estimate at $0".]
Coverage Table
Click Coverage Table to verify that the incorrect percentage has not been entered for the procedure. If the percentage shows 0%, insurance portion will be calculated at 0%. Percentages can also be set for specific procedures.
[edit coverage table open with a category opened, then a subcategory also opened. Showing a different percentage in the main category, then the sub category, then the individual procedure]
Edit Plan Details
Click Edit Plan Details where the options for Age Limits, Downgrades, Frequencies, Waiting Periods, and Deductible Exemptions are listed.
[insurance coverage section with edit plan details in a box]
Check if the Age Limits are incorrect. Hover over the group to click the edit icon to make necessary changes. The age listed will be included in coverage.
[age limits with pencil icon in a box]
Click on Downgrades to verify the incorrect procedures have not been entered. Hover over the procedure and click the edit icon to adjust a downgrade to the correct procedure and site specifications. Insurance will estimate based on the cost of the downgraded procedure.
[downgrades with pencil icon in a box]
Click on Frequencies to verify they are not incorrectly entered in for the procedure groups. If the Frequency column is Not defined, no frequencies are being taken into account. Frequencies are applied against all procedures in the group when one procedure from the group is completed.
[frequencies tab with a group and codes in a box]
If a group is covered per site, edit the group to include this information. Insurance will calculate at $0 if no site specification is entered when codes are completed by site.
[Frequencies with a group in the edit screen with site in a box]
Click on Waiting Periods to verify the incorrect time has not been put in for the procedure. Waiting periods can also be set for specific procedures, indicated with the information icon.
[waiting periods with a group expanded, box around waiting period put in for a specific code. Box around i icon with box reading "Locate the information icon to know if there are waiting periods for specific procedures in a group"]
Click on Deductible Exemptions to verify the incorrect exemption has not been put in for the procedure. Hover over the procedure and click the edit icon to correct it.
[deductible exemptions with a category expanded, the edit icon for a procedure in a box]
Fee Guide
Check which Fee Guide is selected to show on claims in the Plan Information section. The fee guide that is selected is used to calculate what cost is estimated to be covered by insurance.
[edit plan information page with Fee Guide in a box]
Check the specific fee guide to verify the costs are correct and match the procedures being used by going to Administration > Fee Guides and clicking into the correct fee guide.
[Administration menu with fee guides expanded and a box around the fee guide matching the one in the previous image]
If no cost is associated with the procedure, insurance will calculate at $0. Double click the cost to update it.
[fee guide with cost in a box with text "Double click the cost to update the procedure total"]
If the procedure is not listed in the fee guide, it may not have an insurance code attached to it.
Procedure code setup
If a procedure code does not show in the fee guide, see why by clicking into Administration > Procedures > Procedures, then selecting Search. After procedures load on the screen, you can use the search tool to find a specific procedure from the list.
[Administration with procedures drop-down open, then with procedures in a box and search in a box]
Click inside the Search box and type in the code you want to check. When the code appears, scroll to the right and check to make sure there is an insurance code. This will need to be added in order for a procedure to show on a fee guide.
[procedure searched with a box around insurance code column, showing a code entered]
Once an insurance code is entered, or when a new procedure is entered, a new temporary fee guide will need to be created to update the existing fee guides with the new procedure code.
Remember: Changes to the insurance plan affect all patients with the same plan. It is important to always enter all pertinent information.
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